HomeMy WebLinkAbout1996-008643 - tear-off/re-roof PERMIT
CITY OF ORONO PERMIT TYPE:
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2750 Kelley Parkway- P.O. Box 66
Permit Number: =:��i��='�:,�1.:=:
Nrystal Bay, Minnesota 55323 Date Issued:
(612) 473-7357 _....... ._ ��%"`�`E:
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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oal Fee: $ Date Received:
_ Entered By: Permit#: �"�"`�3
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: 1��0 &�,.,S ��'" `1_I� ZIP:
NAIVIE OF OWNER: 1 U►D (>,,�./I,qP PHONE: (home) �/7/ • q0��
(work)
MAILING ADDRESS: /��Q �� �� CITY: Ca(1G�Cs ZIP:
CONTRACTOR: �`��-��L PHONE: S�3 •S.3Z5'
CONTACT PERSON: MOBILE/PAGE :
MAILING ADDRESS: ��S f'w� t°d CITY: ZIP: S� 2Z
STATE LICENSE: # ,3�y 7
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: �,� vi=G �� f��� �G�-R,q cc;�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $�3T'�IOC� " ��_
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: �j� DATE: I� ' �$� `�'L
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SCfB.TECTS OF D�TA
Subd. 1. Type of data. The righ[s of individual on whom[he data is stored or to be stored shall be as set forth in this�ecdon.
Subd.2. Information required to be given individual. An individual asked[o supply private or confidendal data concerning himself shall
be informed of: (a)the purpose and intended use of Ihe requested data within the collecdng'state agency,polidcal subdivision,or sratewide system;
(b)whe[her he may refuse or is legally required to supply[he reques[ed data;(c)any known consequence arising from his supplying or refusing to supply
priva[e or confidenrial data;and(d)the idencity of ocher persons or endaes au[horized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply invesrieadve dara, pursuant to secdon 13.82, subdivision 5, to a law enfoccement ofFicer.
The commissioner of re�enue mav place the noace required under this subdivision in the individual income tax or propertv tax refund
insttuctions instead ot on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her ic is classified as pubiic, privace or confidendal. Upon his further request, an individual who is the subjecc
of stored priva[e or public data on individuals shall be shown[he data wi�hout any charge to him and, if he desires, shall be informed of the content
and meaning of chat data. After an individual has been shown che private data and informed of its meaning,the data need no[be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shali provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person ro pay the actual costs of making, cenifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of
the date of the request,excluding Saeurdays,Sundays and leeal holidays,if immediate compliance is no[possible. If he cannot comply with the request
within that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pm�ate
data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing[he narure of the disagreement.
The responsible authoriry shalt within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correc[. Data
in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data', we would like to inform you that your request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or license.
3. T'he information may be shared with other local, state or federal agencies to the extent necessary to process
the pemut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
(. Your full name is required to process this application or permit.
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First M�ddle Last
�3�5 �l 1 �-�, ir
Address /� ' �f`�'�Z �y�,�3 Z�
' �I/I/S ���1 ,7
��ty State Zip Phone
I understand my rights as stated above.
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Signature